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Kaiser Minimum Coverage HMO

Kaiser Minimum Coverage HMO	In-Network
Cost Share Information
Individual Deductible	$7,150
Family Deductible	$14,300
Out of Pocket Limit-Individual	$7,150 (including deductible)
Out of Pocket Limit-Family	$14,300 (including deductible)
Co-Insurance	0%
Lifetime Maximum	Unlimited
Office Visits
Primary Care	No charge visits 1-3; 0% after deductible visits 4+
Specialist	0% after deductible
Adult Preventive Care	No Charge
Child Preventive Care	No Charge
Maternity Prenatal/Postnatal Care	No Charge
Rehabilitation Services	0% after deductible
Chiropractic Care	Not Covered
Inpatient Services
Inpatient Hospital	0% after deductible
Maternity Delivery/Inpatient	0% after deductible
Outpatient Services
Outpatient Facility	0% after deductible
Mental Health Outpatient	No charge visits 1-3; 0% after deductible visits 4+
Lab/X-Ray	0% after deductible
Emergency Care
Emergency Room	0% after deductible
Urgent Care	No charge visits 1-3; 0% after deductible visits 4+
Ambulance	0% after deductible
Prescription Drugs
Rx Deductible	Integrated Medical/Rx
Rx Generic	0% after deductible
Rx Preferred	0% after deductible
Rx Non-Preferred	0% after deductible
Recovery/ Special Needs
Home Health Care	0% after deductible; 100 visits per year
Durable Medical Equipment	0% after deductible

Optional Benefits	None

Complete Benefit Summary

If you you have questions about the Kaiser Minimum Coverage HMO plan or any other plans from Kaiser Permanente of California please call The Lynn Company at (800)-326-5966 for more information on California Health Insurance Plans.

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